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Tag Archives: ACMHN

This post is a companian piece to my oral presentation at the Australian College of Mental Health Nurses 42nd International Mental Health Nursing Conference, 25 – 27 October 2016, Adelaide Convention Centre (the conference hashtag is #ACMHN2016). The function of the online version is to be a collection point to list references.

The Prezi is intended as an oral presentation, so I do not intend to include a full description of the content here.

Regular visitors to meta4RN.com will recognise some familiar themes. Let’s not call it self-plagarism (such an ugly term), I would rather think of it as a new, funky remix of a favourite old song. Due to this remixing of old content I’ve included previous meta4RN.com blog posts on the reference list (which, in turn, makes the reference list look stupidly self-referential).

Have you ever heard someone say something like, “Twitter doesn’t interest me – I don’t care what Justin Bieber had for breakfast”? Those people speak that way because they don’t understand the difference between personal, official and professional use of Twitter or social media more generally. Data will be presented about nurses using Twitter in a constructive, professional way, with the aim of allaying the fears of those in the pre-contemplation phase, and encouraging those in the contemplation and action phases. In recognition of nursing being a predominantly female profession, a feminist argument will be introduced that aligns the use of social media with empowerment. It will be argued that Twitter can enable and ennoble mental health nurses to engage with people beyond the “walled gardens” of our work silos, our profession, and our conference. Participants will be encouraged to have their mobile phone/tablet/laptop turned on and in use during the presentation, in the hope that we will have a shared conversation on the subject. Why on earth would a mental health nurse bother with Twitter? Answers and challenges will be available to those who attend this presentation and/or follow the conference hashtag #ACMHN2016.

New South Wales Nurses and Midwives Association [nswnma]. (2014, July 30). Women now have unmediated access to public conversation via social media for 1st time in history @JaneCaro #NSWNMAconf14 #destroythejoint [Tweet]. Retrieved from https://twitter.com/nswnma/status/494313737575096321

“What can mental health nurses learn from the amazing story of a catholic patron saint?” was initially submitted as an #ACMHN2016 oral presentation, but accepted as a conference poster. So, instead of updating and reworking the YouTube presentation (as I had planned), I started again. I’m not sure that the poster meets the brief (well, abstract) as well as an oral presentation would have, but anyway…

Abstract

Mental health nursing has a long tradition of story-telling as a tool for developing relationships, undertaking mental state assessment and informing clinical practice. This presentation aims to add to mental health nursing’s discourse about “how we do business”, and add another layer of cultural diversity to our narrative and identity. A review of the literature regarding a catholic patron saint called Dymphna has been undertaken. This will be summarised and presented in a manner in keeping with philosopher Alain de Botton’s proposal that religious teachings should not be trusted to the religious alone – they can be re-purposed and re-mixed to inform atheists too. The historical and mystical story of a 7th century European teenage martyr and saint will be aligned to 21st century Australian language and values. Dymphna’s tale takes unexpected twists and turns which will raise questions about Australia’s appetite for innovative models of mental health care, and whether more could be done to promote mental health nursing as a profession and an identity. This presentation will appeal to those interested in consumer-focused mental health care, innovative alternatives to mainstream care, celebrating mental health nursing, and amazing stories.

In an effort to engage conference delegates in the story of Dymphna, the poster has been made in a colourful quasi-comic style. At time of writing this (a fortnight before the conference starts), I feel a bit anxious that someone will misinterpret the effort to visually engage people as trivialising the subject. This is a bit of a worry, because Dymphna’s story includes nasty stuff, not the least of which includes threatened incest, family violence and two people being beheaded. Even Donald Trump would know that these are not topics to be trivialised.

Although I don’t treat Dymphna’s story with the same reverence as The Pope, I do hold the stories I learnt as a catholic schoolboy with a nostalgic affection. My telling of Dymphna’s story is through the prism of a happily-lapsed-catholic, and with the words of Kirsch [see reference list above] ringing in my ears: “This narrative is without any historical foundation, being merely a variation of the story of the king who wanted to marry his own daughter, a motif which appears frequently in popular legends.” Dymphna’s amazing story is a centuries-old remix of a made-up myth. It’s not the news.

That nursing is the largest single component of Australia’s mental health workforce isn’t a surprise. What is a bit unsettling is that the big bubble with 19,048 in it is mislabeled as “Total mental health nurses”.

That’s not true.

Working in mental health does not make you a mental health nurse, in the same way as driving through Bathurst does not make you a racing car driver. Just because you have a basic licence and you are in the right setting, it doesn’t mean you have the skills to perform safely at a high standard. It doesn’t mean you have cred.

Compare this with types of registration listed by AHPRA’s Medical Board (sub-speciality fields and full range of speciality titles not included):

Addiction medicine

Anaesthesia

Dermatology

Emergency medicine

General practice

Intensive care medicine

Medical administration

Obstetrics and gynaecology

Occupational and environmental medicine

Ophthalmology

Paediatrics and child health

Pain medicine

Palliative medicine

Pathology

Physician

Psychiatry

Public health medicine

Radiation oncology

Radiology

Rehabilitation medicine

Sexual health medicine

Sport and exercise medicine

Surgery

Medicine and nursing do not correlate on every detail of specialisation, but still… why such a big disparity between the two in terms of registration? Australians have rated Nurses as the most ethical and honest profession each year for 21 years in a row (1994-2015) [source], but I wonder if the public is aware of a problem with nursing specialities not being given the similar recognition as medical specialities.

Midwives have made their speciality distinctly different in the eyes of the public and other health professionals. I am sure it is a comfort for many expectant parents to know that the person guiding you through pregnancy, labour, childbirth and early parenthood is a qualified specialist and is acknowledged and registered as such.

However, people receiving support/treatment for a mental health condition will not necessarily have a specialist mental health nurse providing that service. It’s quite the opposite of midwifery – the nurse providing care may have no specialised qualifications in mental health. I wonder how service users and the people who love them feel about that.

I’ve been a medical, surgical and high-dependency/ICU nurse, and have worked closely with Midwives. I can tell you with confidence that mental health nursing is as different from general nursing as midwifery is. There are some transferable skills, of course, but midwifery, general nursing and mental health nursing each have a completely different model of care, and a very different way of working with people.

It’s not all doom and gloom though: the Australian College of Mental Health Nurses (ACMHN) have a process to credential suitably qualified and experienced mental health nurses. In the absence of AHPRA being able to discriminate the difference between a general nurse and a mental health nurse, ACMHN are essentially saying, “Leave it to us. We will tell you who is a mental health nurse and who is not.” To be credentialed by the ACMHN, applicants must demonstrate that they:

Hold a current licence to practice as a registered nurse within Australia

Have had at least 12 months experience since completing specialist / postgraduate qualification OR have three years experience as a registered nurse working in mental health

Have been practicing within the last three years

Have acquired minimum continuing professional development points for education and practice

Are supported by two professional referees

Have completed a professional declaration agreeing to uphold the standards of the profession. [source]

There’s more good news: Queensland Health has set targets to work towards a fully qualified, fully credentialed mental health nursing workforce. I wonder if other state health departments are thinking about implementing a similar strategy. It might be important: a program staffed entirely by Credentialed Mental Health Nurses was described as “one of the most innovative services ever funded” [source].

Credentialing + Ability = Credibility.

Credentialed Mental Health Nurses have Cred.

One last thing. It is encouraging that mental health is not the only nursing speciality in Australia that is setting the standard, for saying, “We the specialist nurses will tell you who is a specialist nurse and who is not”. Under the Credentialing for Nurses initiative, currently there are six specialty nursing organisations working collaboratively to develop consistent, evidence based, recognition for specialist nurses:

Below is a copy of the blog post I was invited to submit at My Health Career. The website is targeted at high school and university students considering or pursuing a career in health, guidance officers, career development professionals, and others working in or with the health care sector.

A Mental Health Nurse in the General Hospital

Paul trying not to look too much like a goob.

Paul McNamara has extensive experience providing clinical and educative mental health support in general hospital and community clinical settings. He holds hospital-based, undergraduate and post-graduate qualifications, is Credentialed by the Australian College of Mental Health Nurses (ACMHN), and has been a Fellow of the ACMHN since 2007. Paul is a very active participant in health care social media, and is enthusiastic about nurses embracing “digital citizenship”. More info via his websitemeta4RN.com

There is an odd little sub-speciality of mental health services called “consultation liaison psychiatry”. This waffly, jargon-ridden mouthful of syllables is usually abbreviated to “CL”. What is CL? Easy – just think of it as “general hospital mental health”.

I’m a mental health nurse on a CL team. The only ward in the hospital I don’t visit is the mental health unit (the mental health unit already has heaps of mental health nurses – they don’t need me there). It’s the rest of the hospital I serve: the surgical wards, the medical wards and the maternity unit.

General hospital patients are more at risk of experiencing mental health problems than the general public – being sick is stressful. It works the other way around too: people who experience long-term mental health difficulties are more at risk of becoming physically unwell – being under lasting emotional stress can take a toll on the body.

Nurses, doctors, social workers and other allied health practitioners will phone CL when they have concerns about the mental health of a patient. Sometimes all that is required is a bit of information and clarification about medication or follow-up services available in the community – we do that over the phone. More often, we are asked to meet with the patient and determine what, if any, mental health matters can be sorted-out while they are in hospital.

The most common mental health problems experienced in the community are anxiety and depression – it’s the same in the general hospital – a lot of the people I meet with are experiencing either or both of these conditions. There are other mental health problems like eating disorders and deliberate self harm that sometimes require input from both the medical/surgical team and the mental health team concurrently. Helping-out with planning and providing support and care of these patients is a pretty big part of my job.

Sometimes it’s not the person in the pyjamas (the patient) who needs our support – sometimes it’s the communication, the systems and the clinical staff who benefit most from CL input. This can be in the form of structured education sessions or, more typically, in the form of supporting discussion, reflection and problem-solving on how best to meet the needs of the patient within the limited resources available in the hospital. In this aspect of the job, a CL nurse will try to help the clinicians involved step-back from the busyness and pressures of the hospital ward and take “a balcony view” of what is happening. By taking ourselves out of the chaos of a busy shift and calmly looking back at things with a bit of distance, sometimes we can see how we can “do business” in hospitals a little more constructively.

We also spend a lot of time “undiagnosing” (this is a “neologism” – a made-up word – I heard recently via Sydney psychiatrist Dr Anne Wand). The people we “undiagnose” the most are those who are experiencing grief. There can be a lot of grief in general hospitals, but we try to be careful not to confuse the emotions of grief (sadness, anger, temporary despair etc) with a psychiatric disorder. Grief emotions are often really uncomfortable but they are part of what makes us who we are. We don’t want to “psychiatricise” or “psychologise” the human condition. Grief is not something to be simply fixed; grief is a part of life – a difficult part of life – that is usually successfully navigated without psychiatric input. Support from loved ones and/or social workers and/or specific counselling services can help.

So, that’s an overview of what it is to be a mental health nurse in a general hospital. It’s a varied role where we spend nearly as much time with the general hospital nurses, midwives, allied health staff and doctors as we do with the hospital patients. The role involves direct clinical care, collaborating with colleagues and providing education. For more information on the speciality please visit my website or the consultation liaison nurses special interest group section of the Australian College of Mental Health Nurses website.

Like this:

Monday at the Australian College of Mental Health Nurses (ACMHN) 39th International Mental Health Nursing Conference, we conducted a workshop on Engaging with Social Media. There were three workshop facilitators: Clare Butterfield from Canberra, Communications & Publications Officer (see @ACMHN on Twitter), Paul McNamara (me), Clinical Nurse Consultant from Cairns (see @meta4RN on Twitter) and, our special guest co-facilitator Emily Mignacca (see @emilymignacca on Twitter) graduating student nurse who commences as a RN specialising in mental health early in 2014.

Rather than use a PowerPoint or other traditional presentation method, I wrote the core content of the workshop as a series of Tweets. In real time as the hands-on part of the workshop was in action, we sent the Tweets out from the @ACMHN Twitter account. The Twitter feed on this page twubs.com/ACMHN2013 was projected onto a screen so workshop participants could see the @ACMHN tweets, their own tweets using the conference hashtag and, perhaps most importantly, the comments and interaction from other Twitter users who used #ACMHN2013. It was a successful strategy – I’ll certainly use it again for future workshops on using Twitter.

You are welcome to use all or part of A Twitter Workshop in Tweets below provided you abide by the Creative Commons Licence below. This licence lets others distribute, remix and build upon the work, but only if it is for non-commercial purposes, they credit the original creator and source – Paul McNamara (2013) A Twitter Workshop in Tweets http://meta4RN/tweets – and they license their derivative works under the same terms. You are also welcome to contact me to facilitate/co-facilitate your health care social media workshop. My email is meta4RN [at symbol] gmail.com

Social media allows Collaboration and Partnerships in Mental Health Nursing to transcend time and place: time through collaborative, asynchronous communication; place by being connected to the world’s online clinical communities. This hands-on workshop aims to act as a launching-pad for those who want to turbo-charge the conference theme.

The workshop will be in two parts: The first, briefest part, will introduce four examples of professional use of social media, using Twitter as the primary example. This part of the workshop intends to show participants the value of engaging with social media.

The emphasis will be the second part of the workshop. This will be a hands-on session that will assist participants gain confidence in using Twitter. This part of the workshop intends to equip participants with skills in engaging with social media in a professional capacity. Wifi will be available. Participants are asked to bring:

for those who already have an established Twitter account, the knowledge (ie: the relevant passwords) on how to access it;

a spirit of curiosity and fun!

To reinforce the learning acquired in the workshop, follow-up “skill checks” will be scheduled during conference breaks on Tuesday and Wednesday. Please come along – the workshop facilitators expect it to be a dynamic, fun, enlightening masterclass in engaging with social media.

Emily Mignacca was invited to join in co-facilitating the workshop just a couple of weeks before the workshop. Although Emily missed-out on being named in the pre-conference publicity, her participation on the day was vital. Emily worked hard and did a good job supporting people who were more than twice her age pick-up some of the skills and enthusiasm she has in using social media professionally. You could do worse than follow @emilymignacca on Twitter.

Below is a list of my pre-composed, pre-ordered tweets for the workshop. There were minor adjustments, inclusions and exclusion made as we went along, but mostly we just sent them out verbatim.

The 2013 ACMHN Consultation Liaison / Perinatal & Infant Mental Health Nurses Annual Conference was held on June 6th and 7th, in Noosa – on Queensland’s Sunshine Coast. It is a boutique conference: these two subspecialties account for a tiny fraction of the total mental health nursing workforce. Given the size of these subspecialties, the conference organisers were pleased with the attendance of about 70 nurses, who gathered together from New Zealand and most states/territories in Australia. 70 is probably about par for the course.

The theme of the conference was “Present and Available” – an exploration of the process of presence, being with and affecting change in the variety of settings that we work. This post explores whether social media can also help mental health nurses and their conference content be present and available to others via social media, specifically: via twitter.

Quantitative Data

There were 26 twitter participants using the #ACMHN hashtag over four days (the two conference days being in the middle of this period). Interestingly, only 3 of the 26 #ACMHN participants were delegates (ie: only 12% of those tweeting about the conference were actually at the conference). Let’s look at the make-up of all #ACMHN participants:

3 conference delegates (each of them Australian mental health nurses)

4 Australian mental health nurses, across three states (Victoria, South Australia & Queensland)

2 European mental health nurses (Germany & Netherlands)

2 Australian general nurses (New South Wales & Australian Capital Territory)

2 Australian nurse/midwife academics (both in Queensland)

1 UK nurse academic

1 Australian psychologist

6 Australian health-related agencies

1 Australian health service manager

1 USA physician

2 non-clinicians from the USA

1 mental health clinician?/consumer advocate? from Scotland

It’s surprising and enthusing (to me, anyway), that a boutique conference being held in a small regional Australian city attracted such an eclectic, geographically widespread group of social media participants. The 26 #ACMHN hashtag participants sent 141 Tweets in the timeframe being examined. The three delegates generated 90 #ACMHN tweets, being 64% of the total during the examined period.

Use of the #ACMHN by those away from the conference was almost entirely in the form of retweets – a simple process where one twitter user shares the content of another twitter user, thereby spreading information quickly and widely. Through this compounding, amplifying effect that social media activity has, during the 96 hours being examined the #ACMHN hashtag had a potential reach of over 94,000 (source). Two specific examples of this will be examined below under Twitter is an Amplifier.

Also available is the un-curated (asynchronous and jumbled to read, but complete) transcript here: http://qld.so/tweets

Twitter is an Amplifier

Assuming that a key purpose of a health care conference is to share information, it would be foolish to overlook the amplifying effect of social media. This first example of a simple statement in a presentation on anorexia nervosa, shows how a message reached beyond the 70 people at the conference to a potential audience of over 20,000.

Let me show the maths on that:

579 = the number of people following the @meta4RN Twitter account. So that one Tweet could have been seen by up to 579 people/organisations. I doubt very much that it was seen by that many. Believe it or not, people have better things to do with their time than read every single one of my tweets. Nevertheless there is a very good chance that many dozens, maybe as high as a couple of hundred or so, people see any single tweet sent. That single Tweet was retweeted (ie: shared/passed-on) by five other Twitter accounts, each with their own group of followers, thus:

So, the potential (not actual) audience for that one message delivered to 70 conference delegates suddenly becomes a message that would have been seen by thousands of people. How many exactly? No idea. As long as you pick a number less than 22,274 your guess will be as good as mine.

Another example of Twitter being used as an amplifier is with this Tweet regarding the publications of one of the conference presenters. The bit at the end that reads “Ping #nswiopCS13” can be interpreted as “You people following the Advances in Clinical Supervision conference may also be interested in this”.

One of those in attendance at the Clinical Supervision conference retweeted, as did two Professors of Nursing: one with James Cook University in Cairns, the other with City University in London. So, while the numbers of people exposed to the presenter’s publications via a tweeted internet link is more limited than the previous example, they were also more targeted… nobody values peer-reviewed journal publications more than an academic. It’s good for Chris Dawber’s professional profile to have nursing academics on either side of the world to be aware of his papers and sharing them with their Twitter followers. It is also useful that Chris had his papers bought to the attention of those at/following a Clinical Supervision conference that was being held in Sydney at the same time as our conference. The link to Chris’s papers is here.

This amplifying effect of Twitter comes with a cautionary note… what if I misquoted or inadvertently misrepresented what Catherine Roberts said?

Easily could have.

I don’t doubt that I’ve captured the essence of what Catherine said as I heard/understood it. However, by using quotation marks I have attributed it as a direct quote from Catherine. Now, a few days after the conference, I’m not 100% confident that I have used Catherine’s exact words.

Naturally, I’ll pass-on a genuine and contrite apology to Catherine if I have got it wrong and caused any offence or embarrassment. However, in practical terms, it’s too late – the horse has bolted. For better or worse, there are probably thousands of people who now think that’s what Catherine said.

Another point of risk: all the way through the conference I tweeted out the take-home message from sessions as I understood it (as seen by scrolling through here). What if I’ve missed the point that speaker wanted emphasised? What if I got it wrong?

Does that make social media too scary and dangerous to use professionally? Of course not.

For me, there’s three strategies that these reflections suggest:

Be careful with what you Tweet if you’re attributing it to others. For example, only use quotation marks when you’re sure you have the presenter’s exact phrasing correct. Also, try to make it clear whether the take home message is the presenter’s words, or your own understanding/interpretation.

Encourage more social media conference participation. As with this example from a keynote presentation at the International Council of Nurses 25th Quadrennial Congress, it’s more interesting to have multiple people using social media rather than just one. Multiple participants also makes it less likely that a single participant’s misunderstanding will be read in isolation… a safety in numbers thing.

For presenters: take control of your social media presence – don’t leave it to chance. That’s what I did with my presentation at the conference (see example below).

As you can see above, rather than take the risk of being misunderstood and/or misquoted by a conference delegate tweeting, I did the tweeting myself via scheduled tweets in the lead-up and during my presentation. As I did, you can include links to websites that are relevant to your presentation. This is a good way to keep control over your message. (BTW: a summary of my presentation is online: meta4RN.com/twit)

For presenters, the alternative way to take control of your social media impact from a conference is to announce, “No Live Tweeting Please”. That’s fine – it should be the presenter’s prerogative. However, what you’re actually saying is either, “What I Have To Say Is Too Precious For People Like You To Share” (in which case, should you be talking about it at a conference?), or “I Do Not Understand or Trust Social Media” (which sounds a bit like, “I do not understand or trust traffic lights” – charmingly quaint, but oddly old-fashioned).

Finishing-Up

For those familiar with my web site, you’ll notice that this post is an obvious companion piece to three previous posts:

Through examining and reflecting on this collection of data, I am gathering confidence and understanding of professional use of social media. By sharing it online, hopefully other health professionals will do likewise: more the merrier.

The original (embarrassingly self-agrandiasing) title of this post matches the title of a presentation at the ACMHN Consultation Liaison / Perinatal & Infant Mental Health Nurses 2013 Annual Conference – the theme of which is “Present and Available”. As stated in the conference publicity, this theme offers an opportunity for these sub-specialities of the mental health nursing community to create conversations and explore the process of presence, of being with. At the conference we hope to improve our understanding what constitutes being present and available in the variety of settings and ways that we work.

The presentation is a blatant hard-sell to mental health nurses regarding professional use of social media. Examples of Twitter being used to augment education, conferences, health promotion, and the profile of mental health nursing are cited. Turbo-charging the conference theme, the argument will be made that mental health nurses can go beyond being “present and available”. Through professional use of social media mental health nurses can create the impression of being “omnipresent and always available”.

It wasn’t really until I started putting the presentation together that I realised what I had in mind was mostly a summary of stuff I have already presented online. So, for those interested in the content of the presentation, here are four examples of Twitter being useful for health professionals (click the links for more info):

View from the podium at the opening session of the ACMHN Consultation Liaison / Perinatal & Infant Mental Health Nurses Annual Conference 2012 – I will update with a picture from the podium of the closing session for the 2013 conference ASAP

That’s it for this post. Thanks for dropping-by – please feel free to comment below.

Paul McNamara, 7th June 2013*

* Actually written on June 1st. The presentation is scheduled for 3:30pm on the last day of the conference: Friday 7th June. I’ve scheduled this blog post to be published and publicised via Twitter, Facebook & LinkedIn at 3:50pm – about the time my presentation should be winding-up (tip for conference presenters: the best way to ingratiate yourself to an audience at the end of a conference is to be quicker than expected).